Acute Otitis Media

Question 1

What is acute otitis media (AOM)?

Answer 1

It is defined as inflammation of the middle ear for a period less than three weeks

Question 2

What is the pathophysiological cause of acute otitis media?

Answer 2

A bacterial infection spreading from the upper respiratory tract via the Eustachian tube

Question 3

What are the seven risk factors associated with acute otitis media?

Answer 3

Young Age

Male Gender

Bottle Feeding

Nursery Attendance

Smoke Exposure

Craniofacial Abnormalities

Immunosuppression

Question 4

What are the seven clincial features of acute otitis media?

Answer 4

Fever > 38C

Coryzal Features

Ear Pain/Tugging

Red, Bulging Tympanic Membrane

Tympanic Membrane Light Reflex Loss

Conductive Hearing Loss

Lymphadenopathy

Question 5

What are the two investigations used to diagnose acute otitis media?

Answer 5

Hearing Tests

Ear Swab Microbiology

Question 6

What two hearing test results indicate acute otitis media?

Answer 6

Negative Rinne’s Test, BC > AC

Weber’s Test Lateralises To Affected Ear

Question 7

How is ear swab microbiology used to manage acute otitis media?

Answer 7

It is used to identify the causative organism in order to enable appropriate management guidance

Question 8

What three bacterial organisms are associated with acute otitis media?

Answer 8

Streptococcus Pneumoniae

Haemophilus Influenzae

Moraxella Catarrhalis

Question 9

When is conservative management recommended in acute otitis media?

Answer 9

It is recommended in systemically well patients

Question 10

What is the conservative management option of acute otitis media?

Answer 10

It involves advising individuals that acute otitis media is a self-limiting disease which should resolve within a week

Question 11

When conservative management is used to manage acute otitis media, what safety netting advise should be given?

Answer 11

It should be advised that individuals reattend in cases where clinical features worsen or don’t improve within a period of 3 days

Question 12

What are the two pharmacological management options of acute otitis media?

Answer 12

Simple Analgesia

Oral Antibiotics

Question 13

When is simple analgesia used to manage acute otitis media?

Answer 13

It is administered in all cases of acute otitis media, in order to relieve otalgia features

Question 14

Name two simple analgesia used to manage acute otitis media

Answer 14

Paracetamol

Ibuprofen

Question 15

What are the seven criteria required for oral antibiotic management of acute otitis media?

Answer 15

Systemically Unwell

Persisting Clinical Features > 4 Days

Tympanic Membrane Perforation

High Complication Risk

Immunocompromised

Bilateral Otitis Media < 2 Years Old

Acute Suppurative Otitis Media

Question 16

What is the first line antibitoic used to manage acute otitis media? What course duration?

Answer 16

Amoxicillin

5 - 7 Days

Question 17

What is the first line antibitoic used to manage acute otitis media - in cases where individuals have a penicillin allergy?

Answer 17

Erythromycin

Clarithromycin

Question 18

What is the second line antibitoic used to manage acute otitis media?

Answer 18

Co-Amoxiclav

Question 19

What are the five complications associated with acute otitis media?

Answer 19

Acute Suppurative Otitis Media (ASOM)

Facial Nerve Palsy

Mastoiditis

Meningitis

Brain Abscess

Question 20

What is acute suppurative otitis media?

Answer 20

It is defined as acute otitis media which results in perforation of the tympanic membrane

It persists for a period less than 6 weeks

Question 21

What is the additional clincial feature of acute suppurative otitis media?

Answer 21

Mucopurulent Ear Discharge

Question 22

What is the management option of acute suppurative otitis media?

Answer 22

Oral Antibiotics

Question 23

What is the most apporpriate management option in cases where individuals develop acute otitis media complications - such as mastoiditis?

Answer 23

Urgent ENT referral